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The first 25 slides, exactly as they appear. The full deck has 47 content slides.
Neuro Critical Care
2 Shunt Tap and Shunt Externalization
Built from Jallo — Neurocritical Care Procedure Atlas
What’s inside
4 sections · 47 slides
What a shunt is, and why it fails
First principles before the needle
- Start here: what problem does a shunt solve?
- The parts of a shunt system
- Ventriculoperitoneal shunt system
- Where the fluid is sent (the terminus)
- Malfunction: the shunt's defining problem
- How a failing shunt announces itself
- The five things that can go wrong
- Imaging: building the picture before you act
- Common shunt valve designs
- Reading the skull film and the shunt series
- Disconnected shunt catheter on X-ray
- When imaging is not enough: the shunt-o-gram
The shunt tap
Sampling fluid and testing flow with a fine needle
- The physiology a tap relies on
- Anatomy of the distal catheter
- Why tap a shunt? Two core purposes
- What each purpose buys you
- When NOT to tap: relative contraindications
- Equipment for a shunt tap
- Preparation and positioning
- Manometer measurement of shunt pressure
- Procedure: entering the valve
- Reading the fluid column (the meniscus)
- Aspiration and accurate pressure
- Testing specifically for a distal obstruction
Shunt externalization
Diverting the distal end to an external drain
- What externalization means and when to do it
- The two primary indications
- Handling the infected shunt
- When NOT to externalize: contraindications
- Equipment for externalization
- Medications and preparation
- Positioning at the clavicle
- Externalizing the shunt at the clavicle
- Procedure: incision and finding the catheter
- Procedure: dividing and connecting
- Procedure: closure and drainage setup
Complications and troubleshooting
What goes wrong, and how to rescue it
- The three main complications
- Troubleshooting: a valve that will not tap
- Troubleshooting: resistance on the distal catheter
- Rescue: salvaging a partially retracted catheter
- A shunt tap shows a mobile meniscus. What does it tell you, and what does it NOT?
- Key takeaways
- Neuro ICU Procedure Atlas